Introduction: Prostate cancer patients experiencing double biochemical recurrence (dBCR) after radical prostatectomy (RP) and salvage radiotherapy (sRTx) face clinical challenges. Advanced imaging, particularly PSMA PET/CT, provides insights into recurrence patterns, aiding therapeutic decisions. Methods: This retrospective cohort study included 48 patients with dBCR. Preliminary analysis of 18 patients who underwent restaging PSMA PET/CT assessed baseline characteristics, recurrence patterns, and outcomes, stratified by PSA levels. Results: The average age at RP was 69 years. European Association of Urology (EAU) risk categories included favourable-intermediate (22%), unfavourable-intermediate (39%), and high-risk (39%). All 18 patients received sRTx, with 4 receiving extended EBRT to lymph nodes and prostate, 4 EBRT to the prostate, and 16 receiving intermittent androgen deprivation therapy (ADT). Median PSA at PSMA PET/CT for dBCR was 1.43ng/mL. Recurrence patterns included prostate bed (17%), nodal (17%), and distant metastases (44%); 2 patients showed no radiological recurrence. PSMA PET/CT demonstrated an 89% detection rate, with 70% showing radiological progression at a median of 65 months post-sRTx. Therapeutically, 10 patients started ADT, 9 started androgen receptor pathway inhibitors, and 9 underwent metastasis-directed therapies using stereotactic ablative body radiotherapy or external beam radiotherapy targeting nodal or bone recurrences. Median PSA level at last follow-up was 1.2ng/mL, with 77.5 months mean follow-up post sRTx. Conclusion: PSMA PET/CT reliably detects dBCR, aiding tailored strategies like MDT and systemic therapy. Future research should optimize PSMA-guided treatment pathways to improve outcomes in this population.